LawInfo

By submitting the form below, your inquiry will be emailed directly to:

Marc Whitehead & Associates, Attorneys At Law, LLP
Houston, TX.
Phone: 866-682-1371

* Denotes required field

On what date did the incident or disabilty occur?

What type of incident occurred?

Auto accident
Slip and fall
Dog bite
Railroad accident
Wrongful death
Hurt on the job
Social Security Disability
Long Term Disability Denial
Insurance Claim
Other

What is the extent of your injuries or disabilities?

Were there any witnesses?

Yes
No

Did the police or ambulance respond?

Yes
No

Have you filed a police report?

Yes
No

If you have been treated for your injuries, what are your medical bills?

Do you or other involved parties have insurance that covers you for this type of incident?

Yes
No
Not sure

Have you filed any claims?

Yes
No

Have you talked to another attorney regarding this incident?

Yes
No

Identify by name the individual, Doctor and/or Hospital against whom you believe you have a claim.

* Please have the attorney contact me by

E-mail
Telephone

If by telephone, what is the best time to contact you?


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The information contained in this web site is intended to convey general information. It should not be construed as legal advice or opinion. It is not an offer to represent you, nor is it intended to create an attorney-client relationship.